Provider Demographics
NPI:1235215997
Name:PEHRSSON, BENGT FLORIAN (MD)
Entity Type:Individual
Prefix:
First Name:BENGT
Middle Name:FLORIAN
Last Name:PEHRSSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W DUARTE RD
Mailing Address - Street 2:#301
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9277
Mailing Address - Country:US
Mailing Address - Phone:626-445-0600
Mailing Address - Fax:626-574-8654
Practice Address - Street 1:622 W DUARTE RD
Practice Address - Street 2:#301
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9277
Practice Address - Country:US
Practice Address - Phone:626-445-0600
Practice Address - Fax:626-574-8654
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34472208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A344720Medicaid
WA34472CMedicare ID - Type Unspecified
CA00A344720Medicaid